The Black Veil: Battling Geriatric Depression

Fatigue, silence, hypochondriac behaviour could all be signs of Geriatric Depression. Sangeeta John writes about the symptoms to watch out for and how you can help your elderly parent or relative battle depression.

Mornings used to be hectic for Arvind Desai. An accountant in a small private firm, there was a time when this 58 year old began his day by dropping his kids to school before catching the local train to work each morning. Evenings had him rushing to take the same local train back home, reaching just in time to eat his dinner and sit around with his family before calling it a day. Years went by. His two children grew up. His daughter got married and his son moved to Australia for good. Gradually he developed symptoms of depression, something even his wife could not ascertain till they decided to meet their general practitioner, who then directed them to Dr. Anjali Chhabria, a Mumbai based psychiatrist and psychotherapist.

“He was suffering from fatigue, hopelessness and loss of motivation when he came to me,” she says. After having spent an entire life between work and family, Desai was overwhelmed with a deep feeling of worthlessness. “I don’t know for whom I should continue working or earning money now,” he told Dr Chhabria. She counselled him for months before she could restore his sense of purpose and help him to look forward to other things in life.

“Like Desai, depression may go undiagnosed because the symptoms are generally undermined and attributed to old age,” says Dr Chhabria. “The disturbance in sleep, appetite, mood, and interest and motivation level is generally associated with the age and sedentary lifestyle.”

And Desai is not alone in this. Depression is significantly present among the ageing population or senior citizens. Due to lack of statistics in India, it is difficult to give a number or percentage. “However,” Dr Chhabria points out, “it is suggested one in every four geriatric patients who visit GPs may be suffering from depression.” In a study by Sheikh et al (2014), about 25 per cent of people above 65 years of age with a chronic medical illness suffer from depressive symptoms and 15 per cent suffer from Major Depressive Disorder. Along with the regular symptoms, those with depression are more likely to be anxious about their physical health triggered mostly by any recent physical illness or changes in physical abilities. Old age is associated with a pre-occupation of bodily functions and disorders and is more often linked to hypochondriacal ideas. This is said to be a pre-dominant symptom of Geriatric Depression.

Geriatric Depression is a Real Thing

“While you were all laughing over the Deepika Puadukone- Amitabh Bachchan starrer film Piku, I was living it,” says Sushma Subramanium from Chennai. The film explores a young daughter’s predicament over her father’s obsession with his bowel movements. “What made matters worse was the fact that I had two small kids to raise, and an aging father to look after, who was more often delusional about his health till one day I decided enough was enough and took him to a psychiatrist.” After being in a prolonged state of denial, resistance and resentment, Subramanium’s father finally agreed for treatment and medication. Things have begun to improve ever since but it will be some time before it will be back to normal for the family.

“These hypochondriacal ideas may be so firm that it could almost be delusional,” says UK based psychiatrist Dr Manoj Therayil Kumar. “Depression in old age may also be present with noticeable decline in memory. This may lead to false diagnosis of dementia. Those with depression may have poor cognitive functions that can be misdiagnosed as dementia.” In most cases however, these memory problems are more likely to go away once depression is tackled. Depression is not a natural part of aging. It is often reversible with prompt recognition and appropriate treatment, says Sherry A. Greenberg of the Hartford Institute of Geriatric Nursing, New York University College of Nursing. He cautions that if left untreated, Geriatric Depression may result in the onset of physical, cognitive, functional and social impairment, as well as a decreased quality of life, delayed recovery from medical illnesses and surgery, increased health care utilization and even, suicide in some cases.

Incidentally, depression is the most common disorder found among the elderly as compared to other disorders in India. While there is no specific type of depression which can be attributed to old age, dysthymic depression and situational depression are common. “There is no such depression which is found only in the elderly,” says Dr Chhabria. “It is important to note that medical problems can cause depression in older adults, either directly or as a psychological reaction to the illness.” Geriatric Depression occurs due to common changes that often come later in life, like retirement, medical problems, and the death of loved ones. Cognitive decline, loneliness and isolation, lack of proper support system, reduced sense of purpose, fear of death, anxiety over financial problems or health issues are some of the main causes of depression. “The empty nest syndrome is another main culprit,” points out Dr Chhabria.

Lifting the Black Veil

The good news is that every case can be treated. However, the level and speed of recovery depends upon various factors such as biological response to medication, presence or absence of a support system, affordability and hence continuity of the treatment. “The elderly patients, mostly in their 60s or above, rely more on medication as a form of treatment than counselling,” says Dr Chhabria. In some chronic cases, the patient needs to be on a maintenance dose throughout their lives. Apart from medication and counselling, Dr Chhabria uses an advanced technology called repetitive transcranial magnetic stimulation (rTMS). “It has no side effects and is especially suitable for patients of this age group.” Since most cases are treated effectively for depression, there is minimal rate of relapse. “We use a combination of medication, counselling and or rTMS depending on individual case.” However, “While most people completely recover from depression with assistance, those accompanying brain changes or those with significant decline in brain functions may have difficulty in achieving full recovery,” warns Dr Kumar.

How can Geriatric Depression be avoided? According to AgeWatch Index 2015 complied by HelpAge International,India is among the worst places to grow old. The enabling environment is especially non-conducive when it comes to supporting our senior citizen population. “What we can do as individuals is to build a support system for geriatric patients,” recommends Dr Chhabria. “We organise senior citizen’s group meetings every month, keep recreational activities such as one day picnics, all which helps give them a sense of belonging, purpose and a social support system.”

Fortunately now, individuals have become more aware of psychiatric illnesses and are co-operative and willing to support. The families are made to understand the nature of the problem and how they must deal with the patient. They need to be supportive towards the patient and realign their expectations from them.

Robert D’souza, 71, is blessed with a family who not only cooperated but also ensured timely intake of medicines etc. D’souza was diagnosed with depression and anxiety and his two children took turns to get him to the clinic, and sometimes even adjusted their work timings to ensure he never missed an appointment. “By adopting a positive approach in their communication with them, they encouraged him and also kept him from having negative thoughts,” says Dr Chhabria. Today D’souza spends a large part of the day helping out at his son’s hardware shop and makes it a point to go for his daily walks in the park every evening.

Unfortunately there are also family members who are not completely aware of or even sensitive to psychiatric illnesses, its diagnosis and treatment. They believe it’s all due to the age and there is nothing more to it. Thus, they do not seek professional help and reject clinical options of treatment.

Look at the elders around you. Do not dismiss their silence or inaction to old age. A little care and understanding is all they need. Everybody has the right to live and live it to the fullest.

* Some names have been changed to protect identities*

Sangeeta John spoke to Dr Anjali Chhabria extensively for this article. You can contact Dr Chhabria on:

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